Provider Demographics
NPI:1538364815
Name:RICHARD CARLIN MD PC
Entity type:Organization
Organization Name:RICHARD CARLIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DEPT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-979-2020
Mailing Address - Street 1:2347 LENORA CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3232
Mailing Address - Country:US
Mailing Address - Phone:770-979-2020
Mailing Address - Fax:770-978-3321
Practice Address - Street 1:2347 LENORA CHURCH RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3232
Practice Address - Country:US
Practice Address - Phone:770-979-2020
Practice Address - Fax:770-978-3321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2671Medicare ID - Type Unspecified